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Cited by 42Telemedicine and Telehealth ImplementationDiabetes Management and EducationMobile Health and mHealth Applications

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis

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Correia, Jorge César, Meraj, Hafsa, Teoh, Soo Huat, Waqas, Ahmed, Ahmad, Maaz, Lapão, Luis Velez, Pataky, Zoltan, Golay, Alain·2021·Bulletin of the World Health Organization
DOI 10.2471/blt.19.250068PMC PMC7941107
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Abstract

Objective To determine the effectiveness of telemedicine in the delivery of diabetes care in low-and middle-income countries.Methods We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low-and middle-income countries.We extracted data on the study characteristics, primary end-points and effect sizes of outcomes.Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties.Findings We included 31 interventions in our meta-analysis.We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23;I 2 = 86.70%),-0.20 for fasting blood sugar (95% CI: -0.32 to -0.08;I 2 = 64.28%),0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%),0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%)and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 97.15%).We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; I 2 = 35.94%),-0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%).Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications.Conclusion Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

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  • Three reviews reported that text-messaging or SMS feedback was equally effective in improving HbA1c compared to a teleconference or telephone appointment with healthcare professionals.

    “3 reviews [28, 31, 43] reported that interventions as simple as text-messaging or SMS feedback were equally effective in improving HbA1c, compared to a teleconference or telephone appointment with healthcare professionals.”

    From Effect of virtual care in type 2 diabetes management – a systematic umbrella review of systematic reviews and meta-analysis (2025) · cites this paper as [43]

    In Results > Meta-analysis (Table 2; page not provided), SMS, telephone and video-conference interventions have HbA1c estimates with no statistically significant between-group difference (P = 0.66). That supports a comparison, but it does not establish equal effectiveness; the SMS estimate’s 95% confidence interval includes no improvement. This source is one review, not evidence that three reviews reached that conclusion. (LLM, conf=0.87)

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Authors
Correia, J. C., Meraj, H., Teoh, S. H., Waqas, A., Ahmad, M., Lapão, L. V., Pataky, Z., & Golay, A.
Affiliations
  • University Hospital of Geneva (CH)
  • University of South Wales (GB)
  • Universiti Sains Malaysia (MY)
  • University of Liverpool (GB)
  • Sharif Medical and Dental College (PK)
  • Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
Corresponding author
Correia, Jorge César
ORCID
Venue
Bulletin of the World Health Organization
Publisher
WHO Press
Published
2020-11-29
Volume
99
Issue
3
Pages
209-219B
ISSN
0042-9686 (ISSN-L)
DOI
10.2471/blt.19.250068
PMC
PMC7941107
OpenAlex
W3133983606
Cited by
42
References
58
Citations by year
2026: 6 · 2025: 14 · 2024: 5 · 2023: 10 · 2022: 5 · 2021: 2
FWCI
0.71
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Bulletin of the World Health Organization (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
telemedicine, diabetes management, low- and middle-income countries, HbA1c, fasting blood glucose, medication adherence, diabetes knowledge, self-efficacy, body mass index, lipid profile, telemetry, mobile application
MeSH terms
Developing Countries, Diabetes Mellitus, Glycated Hemoglobin, Humans, Telemedicine, Text Messaging

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